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Year 3- Surgery T&O > T&O - Femoral And Tibial Shaft Fractures And Knee Injuries > Flashcards

T&O - Femoral And Tibial Shaft Fractures And Knee Injuries Flashcards

1
Q

Femoral and tibial shaft fractures: initial Mx points

A
  • Must resuscitate pt and deal with life threatening injuries first (X match units of blood)
  • Assess neurovascular status, especially distal pulses
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2
Q

Femoral and tibial shaft fractures: Rx

A
  • Intramedullary nail and/or plate and ex-fix
    • *Sub trochanteric NOF fractures are not treated with DHS (intertrochanteric are Rx with DHS) and must be treated like a midshaft fracture - with intramedullary nail and screws
  • If open fracture: start ABX, take pt to theatres for debridement and washout
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3
Q

Femoral and tibial shaft fractures: specific complications/risks

A
  • Hypovolaemic shock
  • Neurovascular: sciatic nerve damage, swelling
  • Compartment syndrome
  • Respiratory complications: fat embolism, ARDS, pneumonia
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4
Q

Ankle fractures: what rules do you use?

A

Ottawa ankle rules

Suspect ankle fracture and perform X-ray if:

  • Pain in malleolar (lat or med) zone
  • Tenderness along distal 6cm of posterior tib/fib including posterior tip of malleoli
  • Inability to weight bear both immediately and in ED
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5
Q

Knee injuries: common presentations

A
  • Swelling:
    • Immediate: haemarthrosis = torn cruciates
    • Hours later OR overnight (effusion = meniscus or other ligament tear)
  • Pain:
    • Meniscal: along joint line, on straightening knee
    • vs med/lar margins (collateral ligs)
  • Locking: meniscal tear and obstruction
  • Giving way: instability following ligament injury
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6
Q

Knee haemarthrosis: causes of primary or secondary bleeding

A
  • Primary:
    • Spontaneous bleeding - warfarin, haemophilia
  • Secondary:
    • Trauma - ACL injury, patella dislocation, meniscal injury, osteophyte fracture
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7
Q

Knee injuries: mechanisms of injury

A
  • Collateral ligaments: torn in valgus or varus strains
    • MCL caused by valgus strain on outside of leg
    • LCL caused by varus strain
  • Twisting injuries: lead to meniscus tears or a rupture of the ACL
  • Hyperextension injuries: Ruptured PCL
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8
Q

Knee injuries: unhappy triad

A

Torn medial meniscus, ACL and MCL

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9
Q

Mx of acutely injured knee

A
  • Full examination of acutely swollen knee is very difficult
  • Take X-ray to ensure no fracture
  • If no fracture:
    • RICE + later re-examination for pathology
    • MRI if meniscal/crucifer injury suspected
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10
Q

Dislocation of patella: MOI and Mx

A

MOI: blow to side of knee causes lateral dislocation of patella

Mx of 1st time traumatic dislocation is conservative unless there is osteochondral fracture or medial patellar stabilisers

  • Reduce patella and put in POP for 3 weeks
  • Short cast time with early mobilisation with or without brace and with physio
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11
Q

Fractures of patella: name different ways in which the patella can fracture

A
  • Communited: direct blow, likely to also have damage in underlying femoral condyles - try to reduce and fix, avoid taking patella out
  • Transverse fracture of patella: violent contracture of quads against resistance - usually town in two horizontally - open reduction and early mobilisation
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12
Q

Name a few inflammatory conditions affecting the knee

A
  • Cysts of menisci: usually arises from lateral meniscus, enlarges under capsule, forms a swelling which is tense in certain positions of flexion. Is liable to tear, in which removal of meniscus is better than cyst removal.
  • Other causes: OA/RA, ankylosis spondylitis, gout
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13
Q

Bursitis in the knees: what are the bursae that can become inflamed in the knee?

A

Infrapatellar bursitis - Clergyman’s

Suprapatellar Bursitis

Pre-patellar bursitis - Housemaid’s

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14
Q

Bursitis in knees: Mx and Rx

A

Septic bursitis

  • Admit pt if systemically unwell, is immunocompromised, severe infection in surrounding tissue or has other comorbidities such as RA and diabetes.
  • Will probably need IV ABX

Primary care Mx of bursitis

  • RICE and modify activities which worsen symptoms -Compression
  • Analgesia: paracetamol/NSAIDs
  • Can aspirate fluid if uncomplicated septic bursitis is suspected OR there is very big swelling
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15
Q

Degenerative conditions knee: popliteal cysts

A

Popliteal cysts: common all ages, painless swellings in popliteal fossa, often fluctuate in size

  • Only excise if cause other symptoms
  • Larger/diffuse cysts associated with pathology of knee joint (RA esp)
  • Should address/look at underlying cause, can do synovectomy/dissection of cyst
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16
Q

What is the commonest joint to get OA?

A

Knee

17
Q

Pathology of OA in the knee

A

Caused by extensive wearing away of joint cartilage, fraying of menisci, marginal osteopaths and some synovial thickening (but little inflammation)

  • Primary: no obvious underlying cause
  • Secondary: follows pre-existing abnormality of joint (fracture, RA, haemarthrosis, meniscal tear, etc)

Joints affected: hips, knees, DIPs, PIPs, thumb and CMC

18
Q

Symptoms of OA in knee

A
  • Pain
  • Stiffness
  • Deformity

Pain pattern: worse with movement and at the end of the day. (RA is early morning stiffness)

19
Q

Ix for OA in knees

A
  • Bloods: CRP may be mildly elevated + Ca/PO4 and ALP all normal
  • X-ray changes:
    • Decreased joint space
    • Osteophytes
    • Subchondral sclerosis
    • Bone cysts
    • Evidence of previous disorders (rheumatoid/congenital defects), structural damage (late sign)
20
Q

Rx for OA in knees: Conservative and surgical

A

Conservative methods

  • Losing wt, using stick, modifying work, analgesics and NSAIDs, physio, heat

Surgical Rx:

  • Arthroscopic lavage/debridement: controversial
  • Osteotomy: esp in younger pts, aims to correct abnormal bone alignment
  • Arthroplasty: knee replacement - most common operation for knee OA, can be total or part
21
Q

Ruptured ACL: specific Mx

A
  • Conservative: rest, physio to strengthen quads and hamstrings, not enough stability for many sports
  • Surgical: autograph repair (gold standard - usually semitendinosus +/- gracilis)
    • tendon threaded through heads of tibia and femur and held using screws.
22
Q

Knee injuries: Tests

A
  • Meniscal Tears: Thessaly’s test - weight bearing at 20 degrees of knee flexion, patient
  • Ruptured PCL: Paradoxical anterior draw test
    *

Year 3- Surgery T&O (16 decks)

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